Fixing Sex

What happens when a baby is born with “ambiguous” genitalia or a combination of “male” and “female” body parts? Clinicians and parents in these situations are confronted with complicated questions such as whether a girl can have XY chromosomes, or whether some penises are “too small” for a male sex assignment. Since the 1950s, standard treatment has involved determining a sex for these infants and performing surgery to normalize the infant’s genitalia. Over the past decade intersex advocates have mounted unprecedented challenges to treatment, offering alternative perspectives about the meaning and appropriate medical response to intersexuality and driving the field of those who treat intersex conditions into a deep crisis. Katrina Karkazis offers a nuanced, compassionate picture of these charged issues in Fixing Sex, the first book to examine contemporary controversies over the medical management of intersexuality in the United States from the multiple perspectives of those most intimately involved. Drawing extensively on interviews with adults with intersex conditions, parents, and physicians, Karkazis moves beyond the heated rhetoric to reveal the complex reality of how intersexuality is understood, treated, and experienced today. As she unravels the historical, technological, social, and political forces that have culminated in debates surrounding intersexuality, Karkazis exposes the contentious disagreements among theorists, physicians, intersex adults, activists, and parents—and all that those debates imply about gender and the changing landscape of intersex management. She argues that by viewing intersexuality exclusively through a narrow medical lens we avoid much more difficult questions. Do gender atypical bodies require treatment? Should physicians intervene to control the “sex” of the body? As this illuminating book reveals, debates over treatment for intersexuality force reassessment of the seemingly natural connections between gender, biology, and the body.

“Fixing Sex marks a groundbreaking contribution to the bioethical literature concerning the medical management of intersex conditions, taking up standard Western medical practice as a cultural artifact burdened with conventional understandings of masculinity and femininity, normal and abnormal, and indeed, medicine and culture. Karkazis’s investigation of the experiences of those involved in the management of ambiguously sexed bodies brings into conversation an unprecedented number of points of view: of persons with intersex conditions, parents of children, and the physicians who treat them. . . . Fixing Sex indubitably demonstrates the importance of the living perspectives of those affected by medical management. It also provides insight into the ways in which history may be essential for biomedical ethical thinking.”, “Fixing Sex is the best book I have ever read over the years which deals with the ethical issues which have plagued the intersex community, parents and doctors. One reason is that it is meticulously researched and in the introduction, the author helps the reader understand her methodology and also makes it transparent and easy to grasp for the reader who is not familiar with such research. . . . Katrina Karkazis has written a book that both I (an intersex activist) and a medical doctor can read and understand and not be upset about. Now that is a tour de force.”, “In addition to interviewing individuals with intersex syndromes and their parents, Karkazis interviewed the clinicians socially authorized to assign and surgically produce gender. Hearing them express in their own words their professional convictions, private doubts,misplaced loyalties, and mounting uncertainties adds a previously missing dimension to the discussion. The accumulated layering of these varied perspectives makes this an insightful, disquieting, appalling, and heartbreaking book. . . . This book will be a vital resource for scholars of gender and sexuality. . . .”, “Fixing Sex is an eloquent and engaging exploration of the ways in which intersexuality is understood, treated, and experienced in the US today. . . . Fixing Sex is a wonderful book that will be of enormous value to individuals with intersex diagnoses and their parents and families, clinicians, counsellors, activists and academics. The book additionally has the ability to empower intersexed individuals and their care-givers to make considered and informed decisions regarding treatment, and validates those who refuse all treatment.”, “Fixing Sex is an important text for scholars concerned with the numerous issues related to ‘intersex’ as well as individuals looking for a comprehensive introduction. As with all research there are many more questions to be answered and examined; Karkazis’ work contributes to the growing body of literature in ‘critical intersex studies’ while pointing the way toward the work that must still be done.”

Katrina Karkazis is a Senior Research Scholar in the Center for Biomedical Ethics at Stanford University.